Urinary Tract
Infections
Tory Davis, PA-C
UNE PA Program
UTI

Can involve any
part of urinary tract
–
–
–
–

Urethra
Bladder
Ureter(s)
Kidney(s)
Bladder and urethra
most commonly
involved
How, who and why



MC pathogen E.coli from GI tract (70-80%)
Also Enterococcus faecalis
In women:
– Close proximity of urethra to anus
– Short distance from urethral opening to bladder

In men:
– more often due to obstruction, incl




Structural abnormalities
Catheterization
Neurogenic bladder
Enlarged prostate
Symptoms Can Indicate
Location
Urethritis causes dysuria
 Cystitis causes:

– Urinary urgency & frequency, hematuria,
suprapubic pain, malodorous urine

Pyelonephritis:
– flank pain, fevers/chills, nausea/vomiting
Risk Factors
Female
 Sexually active
 Use of contraceptive diaphragm and/or
spermicidal agents
 Aging

– Post meno estrogen causes thinner
tissue in vag, urethra, bladder base
More risk factors
For both males and females:
 Urinary tract obstruction
 Immunocompromise
 Urinary catheter 
Work up

History – past UTI, blood present, flank
pain, recent intercourse (new
bacteria),

PE
– + CVAT (costoverterbral angle
tenderness – bang on kidneys) – make
you think pyelo.
Diagnosis

Clean-catch (midstream urine)
– Dip for nitrites (b/c bac-t produce enzyme
that converts urine nitrates to nitrites) and
leukoesterases (protein produced by
WBCs)
– Microscopy for WBCs
– Urine culture and sensitivity
Antibiotics
In an uncomplicated outpt, no catheter
 Bactrim (TMP/SMX) DS (double
strength) bid for 3 days
 Fluoroquinolone (ie Ciprofloxacin) BID
x3d
 Amoxicillin+clavanulate (Augmentin)
 Nitrofurantoin (Macrobid)

And have a heart..

Urinary analgesic phenazopyridine
(Pyridium) 200 mg TID prn dysuria

NB - Makes urine orange or blue
Tx other
Fluids- lots of water
 Avoid bladder irritants- coffee, soda,
alcohol
 Cranberry- decreases ability of bac-t to
adhere to bladder wall

UTI Prevention
Cranberry
 Wipe front-to-back
 Urinate after intercourse
 Avoid irritants, incl feminine hygiene
products and smoking
 Shower rather than bath
 Prophylactic abx for recurrent UTIs

– Dosing: daily low dose vs post-sex dose
vs prn symptomatic dosing
Special populations
require special
considerations
Like who?
 What’s special about them?

Pyelonephritis
Ascending infection from lower urinary
tract travels up ureters to the pyelum
(pelvis) of the kidney (nephros) and
causes an “–itis”
 Or hematogenous spread
 Not good
 Sick people

Pyelo

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Fevers
Rigors
Flank pain
Nausea/vomiting
+ CVAT
+/- lower UTI sx
+ blood cultures
– But good hx and PE, plus urine may be enough
Pyelo Tx
Admission if fevers and leukocytosis
 IV fluids
 IV abx (Cipro, ampicillin if preg)

– Continue abx until fever-free x 24h, but
can switch to oral dosing when pt
improves